3BF-20783-15011
4 vaccinations
1 coded response
20 check-ins
1 free-text entry
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 837 / ID
- Registered
- 2021-02-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-01
Registered in v-safe
-
2021-02-01
Dose 1 — Moderna
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-08
- 2021-02-15
- 2021-02-22
-
2021-03-01
Dose 2 — Moderna
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-04-05
- 2021-04-12
- 2021-05-31
-
2021-08-30
Survey response — 6 months, dose 2MedDRA: Computerised tomogram abnormal, Emergency care, Fibrin D dimer increased, Hospitalisation, Pulmonary embolism, Thrombosis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Array of blood clots in lungs including a saddle clot. Several blood clots in left lower leg. Not sure how long I had leg blood clots but they released to my lungs on 9/8/21. No previous clots or family history or swelling in leg or redness, or pain. · Healthcare visit (other): D-Dimer result 7,000. CAT scan sent me to ER. Hospitalized 3 days on Heparin drip. Sent home on Eliquis. Not certain if Covid vaccine caused blood clots. I am pointing no fingers. I am in good health otherwise.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-30
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-10-07
-
2021-10-14
Call successfulParticipant prefers to complete VAERS report online
-
2021-10-22
Dose 3 — Moderna
- 2022-03-01
-
2022-03-31
Dose 4 — Moderna
- 2022-04-26
- 2022-04-28
- 2022-05-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-01 | Moderna | |
| 2 | 2021-03-01 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-03-31 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 9 — 6 months, dose 2
Symptoms: Array of blood clots in lungs including a saddle clot. Several blood clots in left lower leg. Not sure how long I had leg blood clots but they released to my lungs on 9/8/21. No previous clots or family history or swelling in leg or redness, or pain. cut off by CDC
Healthcare visit (other): D-Dimer result 7,000. CAT scan sent me to ER. Hospitalized 3 days on Heparin drip. Sent home on Eliquis. Not certain if Covid vaccine caused blood clots. I am pointing no fingers. I am in good health otherwise.
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Computerised tomogram abnormal | ✓ | · | ✓ |
| HCVO | Emergency care | ✓ | · | ✓ |
| HCVO | Fibrin D dimer increased | ✓ | · | ✓ |
| HCVO | Hospitalisation | ✓ | · | ✓ |
| HCVO | Thrombosis | ✓ | · | ✓ |
| SD | Pulmonary embolism | ✓ | · | ✓ |
| SD | Thrombosis | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release